Document Detail

Early switch from intravenous to oral antibiotics: guidelines and implementation in a large teaching hospital.
MedLine Citation:
PMID:  10350396     Owner:  NLM     Status:  MEDLINE    
In recent years 'switch therapy' has been advocated: short intravenous antibiotic therapy, for 2-3 days, followed by oral treatment for the remainder of the course. Little is known about the number of patients that could benefit from early switch therapy and the consequences of introducing this strategy in everyday practice. We prospectively registered all antibiotic courses on wards for Internal Medicine, Surgery, and Pulmonology during a 2 month period, before (n = 362, inventorial phase) and after (n = 281, implementation phase) the introduction of guidelines for switching therapy. Approximately 40% of all patients who started on iv antibiotics were candidates for an early iv-oral switch. During the inventorial phase, 54% (52/97) of eligible patients were switched to oral treatment, after a median of 6 days (range 2-28 days). After implementation of the guidelines, this percentage rose to 83% (66/80) (difference 29%, 95% CI 16-42%; P < 0.001). Therapy was also switched earlier, after a median of 4 days (range 2 to 16 days). In the 6 weeks after completion of the oral course, recurrence of infections, or readmissions due to reinfections did not occur. Compared with the inventorial phase, 43% of iv administrations could be avoided, that is >6000 per year. This means a potential annual reduction of dfl.60,000 (c. US$30,000) of administration costs. The potential savings in purchase costs of the antibiotics were dfl.54,000 (US$27,000) annually. In conclusion, a substantial number of patients starting on iv antibiotics were candidates for an early iv-oral switch. The guidelines were well accepted by the physicians and substantial savings in costs and nursing time were achieved.
F Sevinç; J M Prins; R P Koopmans; P N Langendijk; P M Bossuyt; J Dankert; P Speelman
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Journal of antimicrobial chemotherapy     Volume:  43     ISSN:  0305-7453     ISO Abbreviation:  J. Antimicrob. Chemother.     Publication Date:  1999 Apr 
Date Detail:
Created Date:  1999-10-12     Completed Date:  1999-10-12     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  7513617     Medline TA:  J Antimicrob Chemother     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  601-6     Citation Subset:  IM    
Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands.
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MeSH Terms
Administration, Oral
Anti-Bacterial Agents / administration & dosage*,  therapeutic use
Costs and Cost Analysis
General Surgery
Hospitals, Teaching*
Infection / drug therapy*
Infusions, Intravenous
Internal Medicine
Prospective Studies
Pulmonary Medicine
Time Factors
Reg. No./Substance:
0/Anti-Bacterial Agents

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